IV Therapy Introduction - Student Notes (PDF)

Pharmacology Clear & Simple, A Guide to Drug Classifications and Dosage Calculations, Fourth Edition. Chapter 2 Basics of Pharmacology Copyright ©2022 F.A. Davis Company  Learning Outcomes  De...

Pharmacology Clear & Simple, A Guide to Drug Classifications and Dosage Calculations, Fourth Edition. Chapter 2 Basics of Pharmacology Copyright ©2022 F.A. Davis Company  Learning Outcomes  Define key terms.  List the four steps in the drug cycle and their effects on the body.  Differentiate between the therapeutic level and potency of a drug.  Describe how drugs can interact.  Differentiate between a side effect and an adverse reaction.  Compare and contrast the usefulness of different drug resources. Copyright ©2022 F.A. Davis Company  Key Terms  Absorption  Half-life  Adverse reaction  Idiosyncratic  Agonist  Pharmacokinetics  Antagonist  Receptors  Bioavailability  Side effects  Biotransformation/  Synergism Metabolism  Teratogenic  Distribution  Toxic  Excretion Copyright ©2022 F.A. Davis Company  What Is Pharmacology?  Exploration of substances used to: Heal Comfort the sick Help us live longer and healthier lives Copyright ©2022 F.A. Davis Company  The Drug Cycle  Four phases: Absorptio n Distributio n Metabolis m Excretion Copyright ©2022 F.A. Davis Company  Absorption  Process of a substance moving from administration site to bloodstream  Speed of absorption depends on Route of administration ‒ Topical: Condition of skin (scars, tattoos, etc.) ‒ Systemic: Oral, intravenous, injection Fat solubility, pH, and medication concentration Length of contact Age Food Depth of breathing Copyright ©2022 F.A. Davis Company  Critical Thinking  Explain how to overcome the following issue to increase absorption and bioavailability of an inhaled drug. A patient who is taking shallow breaths and is unable to follow directions to “breathe deeply” Copyright ©2022 F.A. Davis Company  Distribution  Delivery of a drug to the site in need after it has been absorbed into the bloodstream  Tissues are either permeable or non-permeable  Barriers to distribution Blood–brain barrier Blood–testicular barrier Blood–placental barrier Copyright ©2022 F.A. Davis Company  Critical Thinking  Why do drugs that cross the blood– brain barrier tend to have strong negative effects?  Why should a woman actively trying to get pregnant consult her physician before taking an over-the- counter medication? Copyright ©2022 F.A. Davis Company  Metabolism  Also known as biotransformation  Medication is gradually transformed to a less active or inactive form (metabolite)  Required to break a foreign substance down  Organs responsible for metabolism: Liver: Most of the work of drug metabolism Kidneys Intestines Copyright ©2022 F.A. Davis Company  Metabolism (continued)  Biotransformation determined route of administration Stomach acid may inactivate or break down medications  Prodrugs are drugs that are administered in an inactive form and the metabolite is desired as a treatment  Affected by age, genetics, disease states, and other factors Copyright ©2022 F.A. Davis Company  Clicker Question The following is an example of a drug that if given orally will be inactivated through metabolism: A. Penicillin B. Digoxin C. Insulin D. Dextrose Copyright ©2022 F.A. Davis Company  Clicker Question Answer: C Insulin, if given by mouth, is virtually useless because stomach acid breaks it down to an inactive form before it can be absorbed into the bloodstream. Copyright ©2022 F.A. Davis Company  Critical Thinking David is a chronic alcoholic. How could the damage to his body caused by alcohol affect the way his body metabolizes drugs? Copyright ©2022 F.A. Davis Company  Excretion  The process by which waste products are removed from the body Kidneys are main organs of excretion Lungs, bile, saliva and sweat glands, and breasts also excrete small amounts Cumulation: Build up of medication in the body leading to illness Excretion limits exposure to medication Copyright ©2022 F.A. Davis Company  Clicker Question What stage of the drug cycle would be a concern in a patient who has liver failure: A. Absorption B. Distribution C. Metabolism D. Excretion Copyright ©2022 F.A. Davis Company  Clicker Question Answer: C The liver is the primary organ involved in metabolism, and failure of the liver would have a major impact on drug metabolism. Copyright ©2022 F.A. Davis Company  Side Effects versus Adverse reaction Side Effects Adverse Reaction  Usually mild,  Severe side effect allowing patient to that can cause continue taking harm or death medication  Examples  Examples hallucinations nausea hypotension constipation anaphylactic shock photophobia drowsiness Copyright ©2022 F.A. Davis Company  Clicker Question Electrolyte imbalances are a side effect of which system? A. Genitourinary B. GI C. Neurological D. Liver Copyright ©2022 F.A. Davis Company  Clicker Question Answer: A Genitourinary system side effects include fluid and electrolyte imbalances, high potassium levels, and increased BUN levels. Copyright ©2022 F.A. Davis Company  Pharmacology Clear & Simple, A Guide to Drug Classifications and Dosage Calculations, Fourth Edition. Chapter 3 Patient Safety in Medication Administration Copyright ©2022 F.A. Davis Company  Learning Outcomes  Define all key terms.  List the seven rights of medication administration.  Explain the various considerations of medication administration.  Identify common abbreviations used in medicine administration. Copyright ©2022 F.A. Davis Company  Learning Outcomes (continued)  Outline special considerations when administering medications to the elderly and to children.  Discuss the cultural effects on drug use.  Name the actions taken during an emergency with a patient. Copyright ©2022 F.A. Davis Company  Key Terms  Anaphylaxis  Pediatric  Antihypertensive  Polypharmacy  Geriatric  Seven rights of  Health Insurance medication Portability and Accountability Act administration (HIPAA)  Teratogen  Lavage  Thrombolytic  Occupational Safety  Urticaria and Health Administration (OSHA) Copyright ©2022 F.A. Davis Company  Patient Rights for Safety  Right patient: Know the patient  Right drug: Know correct medication  Right dose: Know correct dosage  Right time: Know correct administration time  Right route: Know correct route of administration  Right route and technique: Know correct technique for the ordered route Copyright ©2022 F.A. Davis Company  Critical Thinking Rachael S. has been told to be NPO after midnight before an x-ray series of her bowels. She calls to see whether she should take her morning dose of insulin. An office assistant says that she should take it because insulin is not given by mouth. If you had taken her call, what would you have said or done? Explain your answer. Copyright ©2022 F.A. Davis Company  Critical Thinking You enter the reception area of a medical office to look for the patient whose name is on the medication container. How can you be certain of giving the medication to the right patient? Because patients are sometimes confused or hard of hearing, how can you be certain that the patient who responds is the right one? Copyright ©2022 F.A. Davis Company  Critical Thinking What kinds of drugs are usually prescribed to be given at equal intervals throughout the day? Explain why these drugs must be given at exact intervals. What could happen if doses are missed? Copyright ©2022 F.A. Davis Company  Abbreviation  a.c.-------before meals  bid-------twice a day  ID--------intradermally  IM-------intramuscularly  IV--------intravenously  NPO-----nothing by mouth  p.c.------after meals  PO-------by mouth  PRN------as needed  qid--------four times a day  SQ--------subcutaneously  Copyright ©2022 F.A. Davis Company tid--------there times a  Clicker Question The abbreviation NPO means: A. By mouth B. Per rectum C. Nothing by mouth D. Immediately Copyright ©2022 F.A. Davis Company  Clicker Question Answer: C Nothing by mouth is abbreviated NPO. Copyright ©2022 F.A. Davis Company  Factors Affecting Medication Administration  Nutrition  Age  Gender  Culture  Environmental Factors  Pregnancy  Organ Dysfunction Copyright ©2022 F.A. Davis Company  Clicker Question Verifying that the medication is to be injected into a muscle is what right? A. The right time B. The right route C. The right technique D. The right documentation Copyright ©2022 F.A. Davis Company  Clicker Question Answer: B The right route refers to the route of administration. Injection into a muscle is the intramuscular route. Copyright ©2022 F.A. Davis Company  Critical Thinking A premature infant in your care is on the medication gentamicin, which you know is ototoxic. What are some ways to minimize the danger to this infant’s hearing? Copyright ©2022 F.A. Davis Company  Critical Thinking Seth comes to the office with a wound that does not seem to be healing. As he is leaving, he states, “I am going to see my herbalist. Your drugs can’t help me!” What would you do or say? Copyright ©2022 F.A. Davis Company  FDA Safe in Pregnancy Rating CATEGO RISK DESCRIPTION EXAMPLES RY A Lowest Studies have not shown a risk Levothyroxine to mother or fetus. (Synthroid) B Slight Animal studies have not Insulin (Humulin shown a risk to the fetus, or if R) they have, human studies have not. C Moderat Animal studies have shown a Furosemide e risk to the fetus, but controlled (Lasix) studies have not been performed on women. D Risky Studies show these drugs may Warfarin cause harm to the fetus, so (Coumadin) prescriber must weigh risk versus benefit; may use if another safer therapy is not available. X Highest Copyright ©2022 F.A. Davis Company Studies have shown significant Castor oil  Critical Thinking If an obstetric patient calls and asks what over-the-counter drugs she can take for a cold, where would you find that information? How would you explain your responses? Copyright ©2022 F.A. Davis Company  Clicker Question Patients requiring smaller doses of medications include: A. Geriatric B. Pediatric C. Obstetric D. Geriatric and pediatric E. Geriatric, pediatric, and obstetric patients Copyright ©2022 F.A. Davis Company  Clicker Question Answer: D Both geriatric and pediatric patients require smaller doses of medications. OB patients generally require the usual adult dose if the medication is considered safe to use in pregnancy. Copyright ©2022 F.A. Davis Company  Critical Thinking How does liver disease affect the accumulation of drugs in the body? Copyright ©2022 F.A. Davis Company  Critical Thinking When a patient arrives for an appointment in a clinic or doctor’s office, what are some ways that they can check in that will maintain their confidentiality? Copyright ©2022 F.A. Davis Company  Clicker Question The substance given to bind with a toxic substance ingested is: A. Water B. Milk C. Sorbitol D. Activated charcoal Copyright ©2022 F.A. Davis Company  Clicker Question Answer: D Activated charcoal is usually given after gastric lavage to bind with any remaining toxin in the GI system and remove it from the body via stool. Copyright ©2022 F.A. Davis Company  Pharmacology Clear & Simple, A Guide to Drug Classifications and Dosage Calculations, Fourth Edition. Chapter 4 Regulations Copyright ©2022 F.A. Davis Company  Learning Outcomes  Define key terms.  Describe the roles of the Food and Drug Administration (FDA) and Drug Enforcement Administration (DEA) in patient safety.  Discuss how drugs are developed.  Distinguish between brand, generic, and trade names. Copyright ©2022 F.A. Davis Company  Learning Outcomes (continued)  Know the slang names for illegal street drugs.  Discuss why some drugs are controlled more strictly than others.  Give an example of a drug from each controlled substances schedule and explain its classification.  Discuss the role of health-care professionals in recognizing and reporting impaired patients and professionals. Copyright ©2022 F.A. Davis Company  Key Terms  Addiction  Food and Drug  Chemical name Administration (FDA)  Clinical trials  Generic name  Compassionate use  Investigational New  Control group Drug (IND)  Controlled Substances  New drug application Act (NDA)  Double-blind  Patent medicine  Drug Enforcement  Placebo Administration (DEA)  Substance abuse Copyright ©2022 F.A. Davis Company  The Food and Drug Administration  Evaluates premarket drugs  Requires that drugs be scientifically researched before approval  Requires proof all drugs are safe and effective  Regulates drug distribution  Once approved by the FDA a drug is added to the United States Pharmacopoeia/National Formulary (U S P/N F)  Adverse reactions are to be reported Copyright ©2022 F.A. Davis Company  Critical Thinking Mr. Dupee is upset that he is unable to obtain a drug in the United States. He knows of a website from which he can order the medication from Mexico. What are the potential dangers of ordering a drug from another country? How would you discuss this with him? Copyright ©2022 F.A. Davis Company  Naming Drugs  Chemical name: First name; shows the mix of chemicals being studied N-acetyl-p- aminophenol  Brand or trade name Tylenol Manufacturer assigns after drug clears Phases 1–3 of clinical trials Always capitalized and many followed by ® or ™  Generic name acetaminophen After the patent has ended, other manufacturers can produce the drug under the generic name Copyright ©2022 F.A. Davis Company  Clicker Question Which of the following is the brand/trade name? A. ibuprofen B. Advil C. Motrin D. 2-(4-isobutylphenyl) propanoic acid E. Advil and Motrin Copyright ©2022 F.A. Davis Company  Clicker Question Answer: E The generic name is lower case (ibuprofen), the trade/brand name is capitalized, and the chemical name is the chemical makeup of the medication. Copyright ©2022 F.A. Davis Company  Drug Control  Drug Enforcement Administration (DEA) Established in 1973 Enforces controlled substance laws and regulations for the United States Combat Methamphetamine Epidemic Act of 2005 ‒ Drugs that do not require a prescription but require ID and signature ‒ Regulates ingredients used to produce crystal meth Copyright ©2022 F.A. Davis Company  Clicker Question The agency responsible for recalling a medication is the: A. FDA B. DEA C. OSHA D. FDA and DEA Copyright ©2022 F.A. Davis Company  Clicker Question Answer: A The FDA may order a recall if a drug has multiple reports of adverse reactions or a particularly serious event such as death. Copyright ©2022 F.A. Davis Company  Drug Control Copyright ©2022 F.A. Davis Company  Controlled Substances Management  In all offices that contain controlled substances Inventory log maintained and checked daily Records kept for 2 years Should be kept in a double-locked safe cabinet If lost or stolen, DEA form 106 must be filed by the prescriber holding the DEA registration number Follow agency policy for disposal Copyright ©2022 F.A. Davis Company  Substance Abuse  Addiction Compulsive desire to take a drug  Tolerance More of the drug is needed to produce same effect  Habituated Psychological dependence  Withdrawal Tremors, emotional distress, and hallucinations Copyright ©2022 F.A. Davis Company  Critical Thinking  A patient calls frequently and begs for more pain medication. The doctor and staff are frustrated by the repeated requests and attribute them to drug-seeking behavior. How would you handle this situation? Copyright ©2022 F.A. Davis Company  Preventing Substance Abuse  Educated regarding the importance of adhering to the ordered dose  Help educate patients about side effects and cautionary situations  Substances should be kept in a locked cabinet and frequently inventoried Copyright ©2022 F.A. Davis Company  Physical Signs of Substance Abuse  Changes in sleep habits (either too much or too little energy alters sleep patterns)  Excessive weight change  Excessive sweating  Excessive tremors  Confusion  Poor coordination or slow reflexes  Jaundice  Dilated or constricted pupils  Needle marks Copyright ©2022 F.A. Davis Company  Behavioral Signs of Substance Abuse  Poor work performance  Sloppy work and frequent mistakes  Moodiness, including restlessness, irritability, withdrawal, defensiveness, and violent temper outbursts  Forgetfulness  Change in personal hygiene (e.g., clothes, bathing) Copyright ©2022 F.A. Davis Company  Substance Abuse and Legal Issues  Supervisor should report impaired behavior to Board of Medicine, Board of Nursing, etc.  If you do not report colleague, you could be held responsible  Follow agency policy for patients who are impaired Copyright ©2022 F.A. Davis Company  Pharmacology Clear & Simple, A Guide to Drug Classifications and Dosage Calculations, Fourth Edition. Chapter 8 Dosage Calculations Copyright ©2022 F.A. Davis Company  Clicker Question The physician orders 500 mg. You have a vial with 250 mg medication in 1 mL. How many milliliters A. 1 will you give? B. 2 C. 3 D. 4 Copyright ©2022 F.A. Davis Company  Clicker Question Answer: C 1 𝑚𝑙 500𝑚𝑔 250 𝑚𝑔 × 𝑥 ¿ 2 mls Copyright ©2022 F.A. Davis Company  Dimensional Analysis Example  The order is for 0.8 grams. The label says 400 mg = 1 tablet. You must find an equivalent between grams and milligrams to convert. (0.8 multiplied by 1000 multiplied by 1) ÷ (1 multiplied by 400) = 2 tablets  Grams and mg cancel out as 1 on top and 1 on bottom, leaving only the tablet unit of measurement. Copyright ©2022 F.A. Davis Company  Dimensional Analysis Example  The physician has ordered 400 mg of amoxicillin. The label states 500 mg/teaspoon. You open have a metric syringe with mL markings. How many milliliters will you administer? (400 multiplied by 1 multiplied by 5) ÷ (500 multiplied by 1) = 2000 ÷ 500 = 4 mL (mg and tsp cancel out, leaving mL) Copyright ©2022 F.A. Davis Company  Special Circumstances: Calculating Pediatric Dosages  Weight frequently  Step 2: Multiply used to calculate weight in kg by the order for 20  Example: The mg/kg/day physician orders 20 mg/kg/day. The patient weighs 450 mg/day 50 pound.  If drug is to be given Step 1: Convert 50 b.i.d. you would pound to kilograms divide this daily dose by 2 (225 mg two times a day). Copyright ©2022 F.A. Davis Company  Special Circumstances: Calculating Pediatric Dosages  Other times  Step 2: medications are Multiply 45 kg ordered as multiplied by 10 mg/kg/dose. mg/dose = 450 mg/dose  Example: Order is  Step 3: daily dose for 10 mg/kg/dose Multiply 450 mg q.i.d. Patient multiplied by 4 doses weighs 100 pound. = 1800 mg/day  Step 1: Copyright ©2022 F.A. Davis Company  Clicker Question (continued_2) How much does a 75-pound child weigh in kilograms? A. 31.5 B. 34 C. 35.5 D. 37.75 Copyright ©2022 F.A. Davis Company  Clicker Question (continued_3) Answer: B 75 divided by 2.2 = 34 Copyright ©2022 F.A. Davis Company  Critical Thinking Some dosages may be numbers that are difficult to decide how to administer. For example, when the dose is 337 mg/dose and the medication comes in 200 mg tablets, what would you do? How many tablets will you give? Whom do you ask for advice? Copyright ©2022 F.A. Davis Company  Parenteral Calculations  Dimensional analysis is the best method for calculation  If electronic regulator pump is used Order written as milliliters over a certain period of time Example: 2,000 mL to be administered over 5 hours Copyright ©2022 F.A. Davis Company  Check Up 8.10: IV Electronic Milligrams per Hour What is the electronic milligrams per hour for the following? 1. 1,000 mL over 3 hours mL/hr 2. 500 mL over 2 hours mL/hr 3. 1,000 mL over 4 hours mL/hr 4. 250 mL over 1 hour mL/hr 5. 150 mL over 3 hours mL/hr Copyright ©2022 F.A. Davis Company  Critical Thinking (continued_1) In a situation in which the flow rate has not been consistent, you see that the IV insertion site is swollen. Would you increase the flow rate to make up the difference? What would you do? Copyright ©2022 F.A. Davis Company  IV Drip Rate Calculation  Manual IV Sets: 60, 10, or 15 gtt/mL stated on packaging (how many drips are in 1 mL)  Formula Copyright ©2022 F.A. Davis Company  IV Drip Rate Calculation Example  250 mL to be infused over 2 hours. Tubing is 15 gtt/mL. Copyright ©2022 F.A. Davis Company  Critical Thinking (continued_2) When you receive an order to infuse fluid and are using manual drip tubing, which would drip faster at the same hourly rate, macrodrip or microdrip tubing? Explain your answer. Copyright ©2022 F.A. Davis Company  Pharmacology Clear & Simple, A Guide to Drug Classifications and Dosage Calculations, Fourth Edition. Chapter 9 Enteral Medications and Administration Copyright ©2022 F.A. Davis Company  Learning Outcomes  Define all key terms.  List the forms in which medications are manufactured for the enteral route.  Differentiate how the different forms of drugs affect the body.  Describe the possible enteral routes for administering medications. Copyright ©2022 F.A. Davis Company  Learning Outcomes (continued)  Describe how to administer oral medications safely.  Discuss the methods for administering medications through nasogastric or gastric tubes.  Explain why prescribers choose certain forms and routes over others. Copyright ©2022 F.A. Davis Company  Key Terms  Buccal  Buffered  Delayed action  Enema  Enteric-coated  Mortar and pestle  Sublingual  Timed-release Copyright ©2022 F.A. Davis Company  Enteral Medications  Any medication that involves the gastrointestinal tract Capsules Tablets Enemas Suppositories  Most common route of administration is oral Copyright ©2022 F.A. Davis Company  Enteral Medications  Oral Solid  Oral Liquid Meds Meds tablet effervescent ‒ scored salts ‒ enteric coated elixir capsule emulsion ‒ timed-release magmas ‒ delayed action powders ‒ extended release solution suspension Copyright ©2022 F.A. Davis syrup Company  Contraindications to Oral Medication Administration  Nausea  Vomiting  Difficulty swallowing  Medication inactivated by stomach acids  Patient is unconscious Copyright ©2022 F.A. Davis Company  Clicker Question Disadvantages of the oral route of administration include all of the following EXCEPT: A.Difficulty swallowing, leading to choking and aspiration B.Stomach acid may inactivate or destroy medication C.Most expensive route D.Food interferes with absorption of medication Copyright ©2022 F.A. Davis Company  Clicker Question (continued_1) Answer: C One of the advantages of the oral route is that it is one of the least expensive routes of administration. Copyright ©2022 F.A. Davis Company  Clicker Question (continued_4) The type of liquid medication that is a mixture of fat/oil and medication is: A. Elixir B. Emulsion C. Magma D. Effervescent salts Copyright ©2022 F.A. Davis Company  Clicker Question (continued_5) Answer: B Copyright ©2022 F.A. Davis Company  Medication Administration Routes  Nasogastric tube  Buccal lozenge  Sublingual ODT  Rectal suppositories enemas suspensions ointments Copyright ©2022 F.A. Davis Company  Clicker Question (continued_6) All medications that can be given by mouth may be given through a gastric/nasogastric tube. A. True B. False Copyright ©2022 F.A. Davis Company  Clicker Question (continued_7) Answer: False Only liquids and those that can be crushed or opened (capsules) may be given via this route. Copyright ©2022 F.A. Davis Company  Critical Thinking Why is the gastrointestinal a popular route for taking medication? Copyright ©2022 F.A. Davis Company  Pharmacology Clear & Simple, A Guide to Drug Classifications and Dosage Calculations, Fourth Edition. Chapter 10 Parenteral Medications and Administration Copyright ©2022 F.A. Davis Company  Learning Outcomes  Define all key terms.  Describe how to apply transdermal patches and other topical medications correctly.  Indicate how to administer ophthalmic, otic, and nasal medications correctly.  Describe how to insert vaginal medications safely.  List precautions for the safe administration of inhalation therapy. Copyright ©2022 F.A. Davis Company  Learning Outcomes (continued)  Choose the correct needle and syringe for parenteral injections.  Indicate how to inject IM, SUBQ, and ID medications safely.  Indicate how to prepare the patient for IV therapy.  Distinguish between the solutions used in IV therapy. Copyright ©2022 F.A. Davis Company  Key Terms  Ampule  Lumen  Calibrated  Parenteral  Emboli  Phlebitis  Gauge  Subcutaneous  Infiltration (SUBQ)  Intradermal (ID)  Topical  Intramuscular (IM)  Thrombus  Vial Copyright ©2022 F.A. Davis Company  Parenteral Medications  All medications that are not introduced into the gastrointestinal system Topical Ophthalmic Otic Vaginal Nasal Inhaled Injectable ‒ subcutaneous ‒ intradermal ‒ intramuscular ‒ intravenous Copyright ©2022 F.A. Davis Company  Critical Thinking What would be the effect of cutting a transdermal patch? Is it advisable? Copyright ©2022 F.A. Davis Company  Clicker Question (continued_2) Medications are given to treat allergies via all of these routes EXCEPT: A. Nasal B. Ophthalmic C. Vaginal D. Oral Copyright ©2022 F.A. Davis Company  Clicker Question (continued_3) Answer: C Copyright ©2022 F.A. Davis Company  Clicker Question (continued_4) Inhalation medications that are easily carried in patient’s pocket or purse are: A. CPAPs B. Nebulizers C. Masks D. MDIs Copyright ©2022 F.A. Davis Company  Clicker Question (continued_5) Answer: D MDIs are handheld devices easily transportable to provide inhalation medication. Copyright ©2022 F.A. Davis Company  Critical Thinking (continued_1) What should you teach the patient about cleaning and or replacing their mask and tubing? Copyright ©2022 F.A. Davis Company  Clicker Question (continued_6) The proper angle to insert the needle in an IM injection is: A. 10° to 15° B. 45° C. 65° D. 90° Copyright ©2022 F.A. Davis Company  Clicker Question (continued_7) Answer: D Copyright ©2022 F.A. Davis Company  Intravenous (IV) Medications and Administration  Injection of medication directly into the vein to: Treat illness Prevent illness Assist with diagnostic procedure Provide nutrition and hydration  Quickest method of administration  Check state regulations for scope of practice allowed Copyright ©2022 F.A. Davis Company  IV Medications  Advantages Rapid absorption Quick relief of symptoms Provides options for medication and fluid delivery Avoids multiple injections Indwelling catheter can be used for more comfort Fastest method in emergency Copyright ©2022 F.A. Davis Company  IV Medications (continued)  Disadvantages Incompatible medications Risk of complications ‒ Infiltration ‒ Embolus ‒ Infection Higher cost Clots can form Copyright ©2022 F.A. Davis Company  IV Fluids  Crystalloids Dextrose Saline Lactated Ringer’s Copyright ©2022 F.A. Davis Company  IV Medication Administration  Infusion: Slow IV administration of large volume of fluid  Piggyback: A separate IV bag and tubing connected to the primary IV tubing to administer medication over a short period of time  IV push: Quick delivery of a small amount of medication in a syringe  Patient-controlled analgesia (PCA) pump Copyright ©2022 F.A. Davis Company  Total Parenteral Nutrition (TPN)  Patient’s digestive system needs recovery time  Placed directly into a large vein via a special long-term IV catheter  Provides well-rounded supply of fluid, electrolytes, calories from fats, proteins, and vitamins Copyright ©2022 F.A. Davis Company  Other IV Fluids  Lipids: Fats containing soybean or safflower oil added to water, glycerin, and egg yolks To provide calories  Blood and blood products Corrects blood loss Provides missing clotting factors for patients with hemophilia Type and crossmatching required to prevent transfusion reaction Copyright ©2022 F.A. Davis Company  Types of lines  IV Peripheral ‒ arms ‒ hands ‒ feet ‒ scalp  Central lines subclavian or internal jugular vein peripherally inserted centra catheter (PICC) mid-line accucath Copyright ©2022 F.A. Davis Company  IV Administration Supplies  Fluid bag or bottle  IV tubing: 6 to 120 inches  Filter  IV pole  All supplies must be sterile Copyright ©2022 F.A. Davis Company  Intravenous Needles  Butterfly needles  Angiocath needle Winged infusion set Straight needle Smaller gauge (21 to Larger gauge (14 to 25) 22) Copyright ©2022 F.A. Davis Company  Complications of IV Therapy  Infiltration: IV fluids leak into surrounding vein  Thrombus (blood clot)  Phlebitis (vein inflammation)  Air emboli: Bubbles released into bloodstream  Particulate material: Small particles that chip away Copyright ©2022 F.A. Davis Company  Clicker Question (continued_8) All allied health professionals may initiate IV therapy and administer IV medications. A. True B. False Copyright ©2022 F.A. Davis Company  Clicker Question (continued_9) Answer: False States differ in allowable scope of practice for allied health professionals such as medical assistants. Copyright ©2022 F.A. Davis Company  Book cover for Understanding Medical- Surgical Nursing, Seventh Edition. Chapter 6 Nursing Care of Patients with Fluid, Electrolyte, and Acid–Base Imbalances Copyright ©2022 F.A. Davis Company  Learning Outcomes  Identify the purposes of fluids and electrolytes in the body.  List the signs and symptoms of common fluid imbalances.  Predict patients who are at the highest risk for dehydration and fluid excess.  Identify data to collect in patients with fluid and electrolyte imbalances. Copyright ©2022 F.A. Davis Company  Learning Outcomes (continued_1)  Describe therapeutic measures for patients with fluid and electrolyte imbalances.  Identify the education needs of patients with fluid imbalances.  Categorize common causes, signs and symptoms, and treatments for sodium, potassium, calcium, and magnesium imbalances. Copyright ©2022 F.A. Davis Company  Learning Outcomes (continued_2)  Identify foods that have high sodium, potassium, and calcium contents.  Give examples of common causes of acidosis and alkalosis.  Compare how arterial blood gases change for each type of acid–base imbalance. Copyright ©2022 F.A. Davis Company  Fluid Balance  Intracellular fluid  Extracellular fluid Interstitial fluid Intravascular fluid Transcellular fluid Copyright ©2022 F.A. Davis Company  Control of Fluid Balance  Pressure sensors Antidiuretic hormone Copyright ©2022 F.A. Davis Company  Movement of Fluids and Electrolytes  Active transport  Passive transport Diffusion Filtration Osmosis Copyright ©2022 F.A. Davis Company  Tonicity  I sotonic Same osmolarity as blood  Hyp ertonic Higher osmolarity than blood  Hyp otonic Lower osmolarity than blood Copyright ©2022 F.A. Davis Company  Fluid Gains and Losses  Gains  Losses Food Sensible Fluid Insensible Copyright ©2022 F.A. Davis Company  Fluid Imbalances  Dehydration Hypovolemia ‒ Causes: Copyright ©2022 F.A. Davis Company  Dehydration Signs and Symptoms  Thirst  Rapid, weak pulse  Rapid, shallow respirations  Low blood pressure  Dry skin and mucous membranes  Skin tenting  Decreased urine output  Increased temperature Copyright ©2022 F.A. Davis Company  Interventions for Deficient Fluid Volume  Monitor daily weight.  Monitor intake and output.  Increase fluid intake.  Treat underlying cause.  Use caution with elderly patients. Copyright ©2022 F.A. Davis Company  Fluid Imbalances  Fluid overload hypervolemia ‒ causes Copyright ©2022 F.A. Davis Company  Fluid Excess Signs and Symptoms  Bounding pulse  Elevated blood pressure  Respirations increased, labored  Distended neck veins  Edema  Skin pale, cool  Increased urine output  Weight gain  Heart failure Copyright ©2022 F.A. Davis Company  Interventions for Excess Fluid Volume  Monitor weight and urine output.  Place in Fowler position.  Administer oxygen.  Administer diuretics.  Restrict fluid and sodium.  Monitor I/Os Copyright ©2022 F.A. Davis Company  Electrolytes are Ions  Cations Positive (+)  Anions Negative (−) Copyright ©2022 F.A. Davis Company  Sodium Imbalances  Normal-  Hyponatremia Sodium deficit ‒ Causes:  Hypernatremia Sodium excess ‒ Causes: Copyright ©2022 F.A. Davis Company  Food Sources of Sodium  Pizza  Canned Na+ vegetables  Canned soups  Salty snacks  Prepared foods Copyright ©2022 F.A. Davis Company  Hyponatremia Signs and Symptoms  Sodium less than 135 milliequivalents per liter  Fluid excess or deficit  Mental status changes  Weakness  Elevated body temperature  Tachycardia  Nausea and vomiting Copyright ©2022 F.A. Davis Company  Interventions for Hyponatremia  Monitor intake and output.  Monitor weight.  Administer IV saline.  Restrict fluids.  Administer diuretics/steroids. Copyright ©2022 F.A. Davis Company  Hypernatremia Signs and Symptoms  Sodium greater than 145 milliequivalents/liter  Thirst  Mental status changes  Seizures  Muscle weakness  Respiratory compromise Copyright ©2022 F.A. Davis Company  Interventions for Hypernatremia  Treat fluid imbalance first.  Monitor intake and output.  Monitor weight.  Administer diuretics.  Restrict dietary sodium.  Treat cause. Copyright ©2022 F.A. Davis Company  Potassium Imbalances  Normal values:  Hypokalemia Potassium deficit ‒ Causes  Hyperkalemia Potassium excess ‒ Causes Copyright ©2022 F.A. Davis Company  Food Sources of Potassium  Sweet potatoes  Beet greens K+  Potatoes  Yogurt  Prune juice  Bananas  Orange juice  Avocados Copyright ©2022 F.A. Davis Company  Hypokalemia Signs and Symptoms  Potassium (K+) lower than 3.5 milliequivalents per liter  Muscle weakness, cramping  Shallow respirations  Weal, irregular, thready pulse  Mental status changes → lethargy  Cardiac arrhythmia and arrest  Orthostatic hypotension Copyright ©2022 F.A. Davis Company  Interventions for Hypokalemia  Treat underlying cause.  Offer potassium-rich foods.  Administer potassium replacement.  Teach patient Signs and symptoms to report Self-administration of supplement Copyright ©2022 F.A. Davis Company  Practice Analysis Tip: Linking NCLEX-PN® to Practice The licensed practical nurse/licensed vocational nurse will  Monitor client intake and output.  Provide care for a client with a fluid and electrolyte imbalance. Copyright ©2022 F.A. Davis Company  Activity: Cue Recognition 6.1 You are visiting Mr. Anand in his home after his discharge from the hospital following a heart failure exacerbation. You note the following meds: digoxin, hydrochlorothiazide, and warfarin. Today Mr. Anand is reporting weakness and “fuzzy” thinking. What action do you take? Copyright ©2022 F.A. Davis Company  Cue Recognition 6.1: Answer Assess the patient for further signs of hypokalemia and collaborate with the case manager or HCP using SBAR. Copyright ©2022 F.A. Davis Company  Cue Recognition 6.1: Answer Rationale  The patient is taking a medication (hydrochlorothiazide) that causes the excretion of potassium.  The patient is showing signs of low potassium (hypokalemia).  Hypokalemia can cause serious cardiac arrythmias, so the nurse should collaborate with the HCP or case manager. Copyright ©2022 F.A. Davis Company  Hyperkalemia Signs and Symptoms  K+ greater than 5 milliequivalents per liter  Muscle twitching and cramps Later muscle weakness  Diarrhea  Low blood pressure  Cardiac arrhythmia and arrest slow, irregular heart rate weal pulse Copyright ©2022 F.A. Davis Company  Interventions for Hyperkalemia  Limit dietary potassium.  Hold potassium supplements.  Administer medications as ordered. Potassium-losing diuretic Cation exchange resin ‒ sodium polystyrene sulfonate (Kayexalate) Create a shift ‒ Insulin with glucose Copyright ©2022 F.A. Davis Company  Calcium Imbalances  Normal level-  Hypocalcemia Low calcium level ‒ causes  Hypercalcemia High calcium level ‒ causes Copyright ©2022 F.A. Davis Company  Food Sources of Calcium  Fortified cereals  Canned salmon Ca++  Spinach  Yogurt  Cheese  Milk Copyright ©2022 F.A. Davis Company  Hypocalcemia Signs and Symptoms  Calcium (Ca++) less than 9 milligrams per deciliter or 4.5 milliequivalents per liter  Mental status changes  Hyperactive deep tendon reflexes  Diarrhea  Cardiac arrhythmia and arrest  Decreased blood pressure  + Trousseau sign  + Chvostek sign Copyright ©2022 F.A. Davis Company  Hypocalcemia Signs and Symptoms (continued) Trousseau sign Chvostek sign Copyright ©2022 F.A. Davis Company  Interventions for Hypocalcemia  Treat cause.  Increase dietary calcium.  Administer medications as ordered. IV calcium gluconate Oral calcium supplements Aluminum hydroxide to bind phosphate Copyright ©2022 F.A. Davis Company  Hypercalcemia Signs and Symptoms  Calcium greater than 11 milligrams per deciliter or 5.5 milliequivalents per liter  Increased heart rate and blood pressure  Skeletal muscle weakness  Decreased gastrointestinal motility Copyright ©2022 F.A. Davis Company  Interventions for Hypercalcemia  Administer fluids.  Administer medications as ordered. Furosemide (Lasix) Pamidronate (Aredia) Zoledronic acid (Zometa) Calcitonin  Hemodialysis Copyright ©2022 F.A. Davis Company  Magnesium Imbalances Mg+  Normal levels-  Hypomagnesemia Low magnesium level ‒ Causes  Hypermagnesemia High magnesium level ‒ Causes Copyright ©2022 F.A. Davis Company  Hypomagnesemia Signs and Symptoms  Magnesium (Mg++) less than 1.5 milliequivalents per liter  Positive Trousseau sign  Positive Chvostek sign  Cardiac arrhythmia and arrest Copyright ©2022 F.A. Davis Company  Interventions for Hypomagnesemia  Treat underlying cause.  Administer magnesium replacement. Copyright ©2022 F.A. Davis Company  Hypermagnesemia Signs and Symptoms  Magnesium greater than 2.5 milliequivalents per liter  Hypotension  Lethargy  Skeletal muscle weakness  Respiratory failure  Cardiac arrhythmia and arrest Bradycardia Copyright ©2022 F.A. Davis Company  Interventions for Hypermagnesemia  Administer IV fluids.  Administer medications as ordered. Loop diuretics (Furosemide) Dialysis Copyright ©2022 F.A. Davis Company  Acid–Base Balance  Normal pH 7.35 to 7.45 LEARNING TIP  The word acid has fewer letters and lower numbers (less than 7.35). Alkaline has more letters and higher numbers (greater than 7.45). Copyright ©2022 F.A. Davis Company  Acid–Base Control  Cellular buffers  Lungs  Kidneys Copyright ©2022 F.A. Davis Company  Acid–Base Imbalances Acidosis Alkalosis  Respiratory  Respiratory  Metabolic  Metabolic The role of the nurse is to identify patients at risk and monitor laboratory test values for significant changes. Copyright ©2022 F.A. Davis Company  Arterial Blood Gas Values: ROME pH pCO2 HCO3 Down arrow Up arrow Horizontal line Respirato ry Acidosis Up arrow Down arrow Horizontal line Respirato ry Alkalosis Down arrow Horizontal line Down arrow Metabolic Acidosis Up arrow Horizontal line Up arrow Metabolic The role of the nurse is to identify patients at risk and monitor Alkalosis laboratory test values for significant changes. Copyright ©2022 F.A. Davis Company Copyright ©2022 F.A. Davis Company  Review Question #1 Where are most body fluids found? 1. Intracellular 2. Interstitial 3. Intravascular 4. Transcellular Copyright ©2022 F.A. Davis Company  Review Question #1 Answer Correct Answer: 1 Copyright ©2022 F.A. Davis Company  Review Question #2 A 76-year-old patient with skin tenting and decreased urine output is most likely experiencing which fluid or electrolyte disorder? 1. Hypernatremia 2. Hypocalcemia 3. Fluid excess 4. Dehydration Copyright ©2022 F.A. Davis Company  Review Question #2 Answer Correct Answer: 4 Copyright ©2022 F.A. Davis Company  Review Question #3 Which electrolyte is most critical to healthy cardiac rhythm? 1. Calcium 2. Sodium 3. Potassium 4. Magnesium Copyright ©2022 F.A. Davis Company  Review Question #3 Answer Correct Answer: 3 Copyright ©2022 F.A. Davis Company  Review Question #4 Which interventions should the nurse initiate for a patient with fluid excess? Select all that apply. weight. 1. Monitor 2. Place in Fowler position. 3. Administer IV fluids. 4. Encourage ambulation. 5. Restrict fluid and sodium. Copyright ©2022 F.A. Davis Company  Review Question #4 Answer Correct Answer: 1, 2, 5 Copyright ©2022 F.A. Davis Company  Review Question #5 What are good food sources of calcium? Select all that apply. 1. Canned tuna 2. Canned salmon 3. Spinach 4. Yogurt 5. Whole grains Copyright ©2022 F.A. Davis Company  Review Question #5 Answer Correct Answer: 2, 3, 4 Copyright ©2022 F.A. Davis Company  Book cover for Understanding Medical- Surgical Nursing, Seventh Edition. Chapter 7 Nursing Care of Patients Receiving IV Therapy Copyright ©2022 F.A. Davis Company  Learning Outcomes  Discuss how the practice of IV therapy is regulated.  List indications for IV therapy.  Assist in planning nursing interventions to prevent IV therapy complications.  Identify common complications associated with IV therapy.  Calculate flow and drip rates for IV solutions. Copyright ©2022 F.A. Davis Company  Learning Outcomes (continued)  Differentiate characteristics of isotonic, hypertonic, and hypotonic solutions.  Explain the differences between peripheral and central venous access devices.  Describe types of central venous access devices.  List indications for subcutaneous infusions (hypodermoclysis). Copyright ©2022 F.A. Davis Company  Chapter Concepts  Fluid and Electrolyte Balance  Nutrition  Safety Copyright ©2022 F.A. Davis Company  IV Therapy  Administration of fluids or medication via a needle or catheter (cannula) directly into the bloodstream Copyright ©2022 F.A. Davis Company  Practice Analysis Tip: Linking NCLEX-PN® to Practice The licensed practical nurse/licensed vocational nurse (LPN/LVN) will  Maintain and remove peripheral IV catheter.  Administer IV piggyback (secondary) medications.  Calculate and monitor IV flow rate. Copyright ©2022 F.A. Davis Company  Indications for IV Therapy  Hydration  Electrolyte replacement  Parenteral nutrition (PN) Peripheral PN (PPN)  Medication administration  Blood product transfusions Copyright ©2022 F.A. Davis Company  Types of IV Infusions  Continuous  Intermittent Primary Piggyback  Direct injection/IV push  Patient-controlled analgesia (PCA) Copyright ©2022 F.A. Davis Company  Methods of IV Infusion  Gravity drip Calculate infusion rate Roller or screw clamp  Electronic infusion devices (EIDs)  Mechanical controllers Copyright ©2022 F.A. Davis Company  Factors Affecting Flow  Change in cannula position  Height of solution  Patency of cannula  Vein condition  Kinks in the cannula or tubing Copyright ©2022 F.A. Davis Company  Osmolarity of IV Solutions  Osmotic concentration-  Isotonic- expands the extracellular volume 0.9% sodium chloride Lactated Ringer  Hypotonic- expands cell volume 0.45% sodium chloride  Hypertonic- expand plasma volume Dextrose 5% in 0.9% sodium chloride 3% sodium chloride Copyright ©2022 F.A. Davis Company  IV Access  Peripheral lie beneath the epidermis, dermis, and subcutaneous tissue  Central catheter tip ends in a large vessel (superior vena cava) Copyright ©2022 F.A. Davis Company  Peripheral IV With Needleless Connector Copyright ©2022 F.A. Davis Company  Gerontological Issues  Monitor for fluid overload. Elevated blood pressure Increasing weight (1kg or 2.2lbs = Bounding pulse Shallow, rapid respirations Jugular venous distention Increased urine output Crackles Copyright ©2022 F.A. Davis Company  Local Complications (Table 7.1)  Hematoma  Thrombosis  Phlebitis/thrombophlebitis  Infiltration/extravasation  Local infection  Venous spasm  Nerve injury Copyright ©2022 F.A. Davis Company  Systemic Complications  Septicemia  Circulatory overload  Venous air embolism  Speed shock Copyright ©2022 F.A. Davis Company  Central Venous Access Devices (CVADs)  Types Non-tunneled central catheter Tunneled catheter Peripherally inserted central catheter (PICC) Implanted vascular port (ex. Mediport)  Rationale for use Parenteral nutrition Chemotherapy Long-term treatment LPN’s role is to assist the RN with assessment. Copyright ©2022 F.A. Davis Company  Central Venous Access Devices (CVADs) (continued) Triple lumen subclavian catheter PICC line Tunnele d catheter Copyright ©2022 F.A. Davis Company  Parenteral Nutrition- Complete IV Nutrition  Contents Carbohydrates ‒ Dextrose most common in PN Proteins/amino acids Electrolytes Trace elements Vitamins Lipids ‒ May be administered as separate solution Copyright ©2022 F.A. Davis Company  Parenteral Nutrition (continued)  Rationale For patients unable to eat or tolerate tube feedings Promotes wound healing Achieves optimal weight before surgery Avoids malnutrition from chronic disease Treats cancer cachexia (wasting syndrome) Copyright ©2022 F.A. Davis Company  Nursing Care of Patients Receiving Parenteral Nutrition  Initial and ongoing assessment Monitor blood glucose. Monitor daily weights. Monitor signs and symptoms of infection. Initiate slowly. Copyright ©2022 F.A. Davis Company  Subcutaneous Infusion: Hypodermoclysis  Process of administering isotonic solutions (most common: 0.9% sodium chloride and 5% dextrose in water) and limited medications subcutaneously.  Rationale Patients with poor venous access Low risk Cost effective Copyright ©2022 F.A. Davis Company  Subcutaneous Infusion: Hypodermoclysis (continued) Advantages Disadvantages  Slow absorption  Risk of edema rate  Limited drug  Decreased severity choices of infection  Site rotation every  Minimal training 24 hr needed Copyright ©2022 F.A. Davis Company  Activity: Cue Recognition 7.1 You are caring for an 80-year-old patient on a medical–surgical unit. She has been your patient for 3 days when you notice a change in her condition. She is receiving 5% dextrose with ½ normal saline @ 125 mL/hr. On assessment, her BP is 180/92, respirations are 25 per minute and shallow, there are crackles in left lower lobe, O2 saturation is 90%, eyelids are puffy, and pitting edema is present in Copyright ©2022 F.A. Davis Company  Cue Recognition 7.1: Answer  Place patient in high Fowler position and notify the registered nurse (RN) to reduce the IV infusion rate. Place patient on O₂ @ 2 L as ordered.  Check medication record for prn orders for blood pressure. Report findings to the RN/health-care provider (HCP).  Use SBAR to report the situation to the HCP. Copyright ©2022 F.A. Davis Company  Cue Recognition 7.1: Answer Rationale  High Fowler position improves lung expansion.  Oxygen increases oxygenation.  Slowing IV reduces fluid load. Copyright ©2022 F.A. Davis Company  Activity: SBAR Hand-Off Report  You are preparing to give a hand-off report at the end of your shift to the oncoming nurse.  Think about the information you should include in the hand-off report.  Now turn to your neighbor and communicate a hand-off report using SBAR.  Afterwards, review suggested SBAR report on next slide. Copyright ©2022 F.A. Davis Company  SBAR Hand-Off Report: Suggested Answers Situation: 80-year-old patient experiencing shallow respirations, eyelids are puffy, pitting edema both feet, O₂ sat 90%, RR 25/min, BP 180/92. PIV with D5 ½ NS infusing at 125 mL/hr; crackles in left lower lobe. Change in condition from yesterday. RN and HCP notified. IV rate reduced to 20 mL/hr, patient in high Fowler position, O₂ started @ 2 L, feet/legs elevated. PRN hydralazine given for Copyright ©2022 F.A. Davis Company  SBAR Hand-Off Report: Suggested Answer (continued) Background: Admitted 3 days ago with UTI. Past medical history of CHF and HTN. Assessment of Situation: The patient may be fluid overloaded due to the IV fluids. Recommendation: Monitor BP, recheck O₂ saturation frequently, monitor lung sounds, and weigh patient every morning. Copyright ©2022 F.A. Davis Company  Review Question #1 The nurse attempts to flush the patient’s IV cannula with saline but meets resistance. Which action is best? 1. Flush the cannula with heparin. 2. Flush the cannula with saline. 3. “Milk” the tubing. 4. Remove and replace the cannula. Copyright ©2022 F.A. Davis Company  Review Question #1 Answer Correct Answer: 4 Copyright ©2022 F.A. Davis Company  Review Question #2 Which IV fluid is hypertonic? 1. 5% dextrose in 0.9% sodium chloride 2. Normal saline 3. 0.33% sodium chloride 4. Lactated Ringer’s solution Copyright ©2022 F.A. Davis Company  Review Question #2 Answer Correct Answer: 1 Copyright ©2022 F.A. Davis Company  Review Question #3 Calculation Practice The patient is ordered 1,000 mL of 0.9% sodium chloride over 6 hours. You have tubing with a drop factor of 10. How many drops per minute will you administer? Copyright ©2022 F.A. Davis Company  Review Question #3 Answer Calculate drip rate: Dimensional analysis 1,000 1 hour 10 gtt = 28 gtt milliliter 6 hours 60 minutes 1 milliliter minute NOTES: Milliliters cancel out. Hours cancel out. Final answer will be in gtt/minute. Copyright ©2022 F.A. Davis Company  Review Question #4 Which medication when given intravenously can cause a life- threatening arrhythmia? 1. Saline 2. Magnesium 3. Furosemide 4. Potassium Copyright ©2022 F.A. Davis Company  Review Question #4 Answer Correct Answer: 4 Copyright ©2022 F.A. Davis Company  Review Question #5 A patient is receiving IV fluids at 100 mL per hour. Which assessment findings would indicate fluid volume excess? Select all at IV site 1. Warmth that apply. 2. Bounding pulse 3. Profuse sweating 4. Crackles in lungs 5. Elevated temperature Copyright ©2022 F.A. Davis Company  Review Question #5 Answer Correct Answer: 2, 4 Copyright ©2022 F.A. Davis Company  Book cover for Fundamentals of Nursing Care: Concepts, Connections & Skills, Fourth Edition. Chapter 38 Intravenous Therapy Copyright ©2022 F.A. Davis Company  Purposes of IV Therapy  Maintaining fluids and electrolytes For clients who cannot drink fluids or ingest fluids, or NPO Electrolytes important for life  Replacing fluid and electrolyte losses When the loss of water is accompanied by the loss of electrolytes, they must be replaced (hypovolemia) Copyright ©2022 F.A. Davis Company  Purposes of IV Therapy (continued)  Infusion of intravenous medications Continuous IV Infusions IV push IV intermittent infusions Compatibility vs. incompatibility (precipitate) Copyright ©2022 F.A. Davis Company  Safe Administration of IV Drugs  Patient’s medication allergies  Patient’s disease or condition  Sterile technique  Integrity of the IV access  Effects of the drug  Correct form of medication for IV use  Correct dosage for specific patient’s age or weight Copyright ©2022 F.A. Davis Company  Safe Administration of IV Drugs (continued)  Type of diluent to use if needed  Volume of dilution required  Rate of safe administration  Expected effects of the medication  Possible drug-drug interactions  Possible adverse reactions  Appropriate nursing interventions Copyright ©2022 F.A. Davis Company  IV Solutions  Isotonic solution Fluid that contains an amount of solute that produces a concentration of dissolved particles equal to the intracellular and extracellular fluids of the human body  Hypotonic solution Fluid that has a lower osmolarity than body fluids  Hypertonic solution Fluid has a higher concentration of particles dissolved in it than the concentration in Copyright ©2022 F.A. Davis Company  Clicker Question Which of the following describes a hypotonic solution? A. Concentration of dissolved particles equal B. Has a lower osmolarity than body fluids C. Has a higher concentration of particles dissolved in it than the concentration in fluids of the body D. Causes water to be pulled from the Copyright ©2022 F.A. Davis Company  Answer Correct Answer: B. Has a lower osmolarity than body fluids A hypotonic solution has a lower osmolarity than body fluids, which simply means there is less solute dissolved in the water, making the concentration of the dissolved particles less than that of the body fluids Copyright ©2022 F.A. Davis Company  IV Equipment  IV needle cannula or catheter  Winged butterfly  IV tubing  IV infusion pump or controller  Intermittent infusion IV access tubing or PRN locks  IV start kit Copyright ©2022 F.A. Davis Company  IV Cannulas  Needles needed for insertion are covered by a plastic sheath called an IV cannula or catheter  Cannula sizes include even numbers from the tiniest 24 G (0.6 mm) to the very large 12 G (2.8 mm)  IV cannulas also come in different lengths from 1/2 to 2 inches (1.2 to 5 cm)  Less irritating to the vein Copyright ©2022 F.A. Davis Company  Winged Butterfly Needles  Scalp-vein needle  It has two small plastic wings to grasp the device while initiating IV access  Winged butterfly sizes include 18 to 27 G (1.2 to 0.4 mm) in diameter and from 3/8 to 1 inch (9.5 to 25 mm) in length  Butterflies may be used to access scalp veins in newborns and infants up to 18 months of age for IV fluids Copyright ©2022 F.A. Davis Company  IV Tubing  Primary IV tubing administration set Primary IV administration set for infusion by gravity Primary IV administration set for infusion by pump  Secondary medication (or IVPB) tubing administration set  Blood administration Y-set Copyright ©2022 F.A. Davis Company  IV Tubing Extenders  Extension tubing Tubing inserted between the patient’s IV cannula and the primary IV tubing for the purpose of extending the length of tubing ‒ Provides more mobility to the patient and provides additional injection ports  Intermittent infusion lock or PRN lock Small device that attaches to the IV cannula in the vein ‒ Provides an injection port on the end through which IV fluids or medications can be administered either continuously or at Copyright ©2022 F.A. Davis Company  Drop Factor  The Drop Factor The number of drops it takes for that specific tubing to equal 1 mL of volume of IV fluid The drop factor number may be found on the tubing package. The range of drop factors in IV tubing includes drop factors of 10, 15, 20, and 60 10 being the largest drop size and 60 being the smallest Copyright ©2022 F.A. Davis Company  IV Infusion Pumps and Controllers  IV infusion pumps and controllers provide protection against accidental infusion of too much fluid  When infusing by gravity, a 1,000-mL bag of IV solution conceivably could accidentally infuse the complete volume in an hour or less Copyright ©2022 F.A. Davis Company  IV Start Kit  Tourniquet Blocks venous blood return allowing the selection of a vein to make an initial stick  Antiseptic prep pad Cleanse the skin site  Sterile gauze pad Dries the puncture site  Sterile transparent occlusive dressing Applied over the insertion to prevent microorganisms  Label  Tape Copyright ©2022 F.A. Davis Company  Asepsis and IV Therapy  Infection can Increase the patient’s discomfort and anxiety; risk of thrombus, or blood clot, formation Decrease the patient’s trust and rapport with health-care providers Increase the nurse’s workload and liability  Use of asepsis during IV therapy cannot be overemphasized Handwashing Copyright ©2022 F.A. Davis Company  Supplies That Must Be Kept Sterile Box 38.4 IV Supplies That Must Be Kept Sterile Maintaining sterile technique during IV initiation is paramount. Because there are “specific parts” of each supply item that must be kept sterile, you will need to be able to identify them on sight while you are manipulating the supplies during IV initiation. You may find it helpful to locate the parts listed below on the actual items. If so, obtain (1) an IV needle with cannula, (2) a primary IV tubing, (3) a bag of IV solution, (4) a PRN lock, and (5) a transparent occlusive dressing. Identify the parts on each item that must be kept sterile: Entire length of the IV needle barrel and cannula or butterfly Opening to the hub of the IV cannula or butterfly that connects directly to the IV tubing end Open end of the IV tubing that connects into the IV cannula or needle hub IV tubing spike, or piercing pin, that enters the sterile IV solution bag IV solution bag insertion port into which the IV tubing spike enters IV solution being infused Adhesive side of the transparent occlusive dressing prior to application Copyright ©2022 F.A. Davis over the IV insertion site Company  Four Solutions Recommended by the INS  0% povidone-iodine  2% tincture of iodine  2% aqueous chlorhexidine gluconate  70% isopropyl alcohol Copyright ©2022 F.A. Davis Company  Infusion Rate Copyright ©2022 F.A. Davis Company  Medical Record Review  Health-care provider’s order  Patient’s medical condition  Patient’s age and mental cognition  Allergies Copyright ©2022 F.A. Davis Company  Preparing the Equipment  Two methods of identification  Obtain correct volume bag of the ordered IV solution  Rate of infusion  Infusion pump or controller  Required tubing administration set Copyright ©2022 F.A. Davis Company  Selecting a Vein Copyright ©2022 F.A. Davis Company  Selecting a Vein (continued) Copyright ©2022 F.A. Davis Company  Performing Venipuncture and Cannulation  Without contaminating the cleansed site, apply the tourniquet 4 to 6 inches proximal to the selected site  Place your nondominant hand distal to the intended puncture site  Use your thumb to pull the skin taut  Hold the needle at a 20- to 30-degree angle to perform the venipuncture Use the direct method or the indirect method for insertion Copyright ©2022 F.A. Davis Company  Performing Venipuncture and Cannulation (continued)  After you have advanced the full length of the cannula into the vein, gently release the tourniquet, remove the needle, attach IV tubing, tape the site, and document Copyright ©2022 F.A. Davis Company  Complications of Peripheral IV Therapy  Infiltration  Extravasation  Phlebitis  Thrombophlebitis  Localized infection  Septicemia  Severed cannula  Air embolism  Circulatory fluid overload  Speed shock Copyright ©2022 F.A. Davis Company  Clicker Question (continued) What is the term for leakage of nonvesicant IV fluid or medication into the tissue surrounding the IV insertion site? A. Infiltration B. Extravasation C. Phlebitis D. Thrombophlebitis Copyright ©2022 F.A. Davis Company  Answer (continued) Correct Answer: A. Infiltration Infiltration can be caused by displacement of the IV cannula outside of the vein, either at the insertion site or by piercing through the other side of the vein, allowing nonvesicant fluid to leak from the vein into the surrounding tissues Copyright ©2022 F.A. Davis Company  Central Venous Access Devices  Peripherally inserted central venous catheter (PICC)  Central venous catheter  Implanted venous access device (implanted port) A single-lumen catheter is a long, thin catheter with one hub at the end. A multiple-lumen catheter is a long, thin catheter with multiple hubs at the end Copyright ©2022 F.A. Davis Company  Central Venous Access Devices (continued)  Complications with vascular access devices include bloodstream infections, pneumothorax, thrombosis, and misplacement Copyright ©2022 F.A. Davis Company  Blood and Blood Products Box 38.10 Examples of Blood Products and Their Uses Research and technology have made it possible to isolate individual components and factors that compose the blood. It is no longer necessary to transfuse whole blood to every patient who only needs specific components. These are examples of specific blood components and possible situations in which they might be administered. Albumin: Increase plasma volume Cryoprecipitate: Replace coagulation factors ONE, SEVEN, and EIGHT Fresh-frozen plasma: Replace coagulation factors FIVE and ELEVEN, drug reversal of warfarin (Coumadin) Liquid plasma: Replace plasma proteins PRBC’s: Acute blood loss, hemoglobin less than 8 to 10 grams per deciliter, symptomatic anemia Platelets: Prevent/control bleeding related to low platelet count, acute leukemia, thrombocytopenia Whole blood: Rarely used but restores blood volume along with all its components; mostly broken down for use of its individual components Copyright ©2022 F.A. Davis Company  Signs and Symptoms of Transfusion Reaction  Chest pain  Itching  Back pain  Watery eyes  Bleeding  Shortness of breath  Vein burning  Mild wheezes  ↑R rate, ↑ P rate, ↓  Wide-eyed BP appearance  Nausea/vomiting  Anxiety  ↑ Temp  Extensive urticaria  Chills  ↓BP  Headache  Severe wheezing  Flushed  Cyanosis  Urticaria Copyright ©2022 F.A. Davis Company